As a physician, one of the most rewarding parts of my job is building relationships with my patients. In developing this connection, I’m able to better understand their healthcare challenges and frustrations, which enables me to ultimately help them achieve their health goals.
But establishing strong patient engagement is getting harder, in part due to the ever-changing regulations and daily demands we as physicians must manage.
Consider this: During a 20-minute appointment, physicians spend only about 12 minutes interacting with the patient and 8 minutes documenting their visit on the electronic health record (EHR). Once the patient leaves, we spend another 11 minutes completing documentation in an effort to keep up with payer demands and comply with other requirements.
While healthcare tech – in the forms of EHRs, patient portals, secure messaging or mobile apps – are proven to help foster stronger connections between physicians and patients, it’s the personal touch, the solid relationship between the patient and the provider, that’s most important.
Building a Trusted Relationship: The Patient <> Provider Connection
Despite best intentions, many healthcare practices fail to provide solid patient experiences. Considering today’s healthcare environment where individuals now foot more of their healthcare bill than ever before, patients are seeking greater value and convenience for their money.
According to a recent study, nearly half of all healthcare consumers are frustrated with their healthcare experiences. Why? Because there is a gap in perception between providers and consumers on the quality of experience currently being provided.
To overcome this disconnect, let’s go back to the basics. As a child, you’re taught that it’s proper etiquette to shake someone’s hand and look them in the eyes when speaking with them. This is true for physicians as well.
The first step in building better relationships with patients is to make eye contact with them. In fact, a recent JAMA study found that patients equate engagement with eye contact from the provider. As simple as this seems, many physicians (myself included) sometimes struggle with this due to the fact that we are heads down in our technology systems.
However, eye contact is a powerful form of nonverbal communication and shows our patients that we are giving them our undivided attention. Trust me – patients notice whether or not their doctors make eye contact. If we are constantly looking at our computer or tablet during an office visit, the patient automatically feels the disconnect and will rate their overall healthcare experience much lower.
Overcoming the Pitfalls of Technology to Improve the Patient Experience
While the human element in healthcare is of paramount importance, there is still a role for patient engagement technology, which can enhance and strengthen our personal relationships with patients. However, practices must make sure these tools are integrated and operate seamlessly. While patient engagement technologies look great on paper, when put into practice, they often require patients to use different apps or access a variety of unconnected systems.
Portals are one of the most common technologies that can be used to engage patients, however research shows that more than 56% of patients have said they’ve never been encouraged to use an online medical record by practice staff, and 47% of patients offered access to a portal have never viewed their health info. In addition to making patients aware that these technologies exist, it’s also crucial to discuss the benefits of patient portals, such as simplified processes for refilling prescriptions, scheduling appointments, reviewing health information and more.
Fostering a Successful Technology-Enabled Patient Engagement Strategy
While it’s true that it takes both people and software to truly engage patients, applications of patient engagement technology can be successful when enabled by a compassionate and sincere strategy. Some key considerations when implementing these technologies include:
By Jeff Solis, senior product marketing manager, eFax Corporate.
Jeff Solis
The survival of highly regulated industries such as healthcare depend on secure information exchange.
Healthcare organizations, or “covered entities,” as they’re known, exchange large volumes of sensitive data daily: billing and medical records, prescriptions and refill requests, lab requisitions, clinical field trial results, patient clinical data, plus insurance claims, denials, appeals, and invoices.
Traditional analog fax, relic that it is, still transmits over the public telephone network, and remains difficult, if not impossible to intercept. For this reason, it is regarded as a more secure form of communication than email. In fact, a report on the health industry’s use of fax machines showed 75 percent of medical communication in the United States takes place via fax. Recent high-profile incidents of massive cyber-attacks exposing the personal details of millions of customers and patients reinforce the view that email remains a highly vulnerable means of business communication.
However, fax remains a viable means of exchanging protected healthcare information (PHI) for other reasons too. A recent IDC study noted that 25% of large businesses surveyed prefer fax over email because they believe it reduces their risk of violating data privacy regulations. An additional 28% prefer fax because it makes document tracking easier and sends alerts as to the success or failure of a transmission.
Then there’s the regulatory factor. Federal regulators who enforce healthcare data-privacy rules have exempted fax (and phone calls) from certain aspects of the HIPAA Security Rules. This has led to the widespread perception that fax is more compliant than other types of electronic communication for the transmission of PHI.
So fax persists. But the world has changed, and so have old notions about fax reliability. In fact, the issue has taken on greater importance with the Centers for Medicare & Medicaid Services Administrator Seema Verma challenging software developers to make physicians’ offices fax-free by 2020.
The Trouble with Legacy Fax
If you still use a fax machine, multifunction printer, or rely upon on-premises fax servers to transmit your faxes, then you support legacy fax.
This is a huge problem! Why? Because legacy fax can fail in ways that threaten an organization’s data security, and if in today’s data-driven world covered entities can’t keep the PHI of patients free from unauthorized exposure, they’d better, well, cover their entities as HIPAA violations are expensive and can torpedo your reputation, even your livelihood.
One of the greatest challenges in healthcare is keeping up with the changing landscape. Considering only since the beginning of 2019, the Centers for Medicare and Medicaid Services (CMS) and other federal agencies, such as the Office of National Coordinator of Health IT (ONC) and the Department of Health and Human Services (HHS), have introduced a number of rules as a measure of upholding their goal of empowering patients and enhancing healthcare efficiency. We’re at a very critical juncture in healthcare and from a regulatory perspective, there are a few key rules that merit a special focus which will have a great impact from both a clinical and financial standpoint.
The MyHealthEData Initiative in 2019
The MyHealthEData initiative, launched in March 2018, aims to “empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure.” Only a few days back, CMS upped the ante for better data access by expanding this initiative and announcing the pilot of “Data at the Point of Care.”
The Data at the Point of Care (DPC) pilot will be connecting providers with Blue Button data, where providers can access claims data to learn more about their patients and their previous diagnoses, procedures, and prescriptions. While providers had to comb through several hundred data sets previously, the DPC program would aim to make access to data easier and right within their workflows.
This announcement follows the relaunch of the Blue Button initiative, or Blue Button 2.0, that grants access to health data and enables patients to send that information using FHIR-based healthcare apps.
In a nutshell, these moves come as an overall push from CMS to promote better access to data and 100% healthcare interoperability. In addition to enabling data access, CMS has also been targeting information blocking, as reflected by 2019 MyHealthEData updates. With these measures, both patients and providers will have the required insights to make more informed healthcare decisions.
The Trusted Exchange Framework and Common Agreement
In April 2019, ONC published its second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), focusing on three high-level goals:
Providing a single ‘on-ramp’ to nationwide connectivity
Enabling Electronic Health Information (EHI) to securely follow the patient wherever needed
Supporting nationwide scalability
TEFCA is basically a common set of principles which serve as “rules of the road” for nationwide electronic health information exchange across disparate health information networks (HINs). The framework, which was mandated by the 21st Century Cures Act, provides a set of policies and procedures along with technical standards required to enable healthcare data exchange among providers, state and regional HINs, and federal agencies.
In the age of internet and online shopping, striving to make it into the future by relying on traditional or outdated practices will get you nowhere! Thanks to the younger generations, various private and public departments are favoring online presence more now and we think, healthcare department should follow suit!
According to a survey by Accenture, the younger generations (millennials and Generation Z) will likely prefer new care models like retail clinics and virtual visits over the traditional methods. This spells trouble for the healthcare department since they still lack the tools to embrace the digital culture.
Digital Transformation in the Healthcare Sector
There is nothing wrong with the traditional health IT sector. It is just that many of the younger generations are outgrowing the traditional methods and now expect a different standard of service.
In the age of self-diagnosis from Google and WebMD, the young individuals constantly express dissatisfaction with the existing healthcare models. They are more comfortable with researching healthcare options online and are more likely to utilize non-traditional methods of engaging with the health department. Because of the reliance on the latest cutting-edge options, healthcare must understand that there is a need to adopt advanced techniques.
Currently, we are living in the digital age and the consumers are always on the lookout for a digital front-end experience. Since the internet has blurred boundaries, the younger generation is more aware of what they want and how they want it. At this point, the healthcare department seriously lacks the necessary digital tool to provide a better experience.
In a way, it is not just about the adoption of certain tools. Instead, we are talking about a complete transformation that will provide the healthcare department with the boost it needs to make things easier for the upcoming generations. The redesign will mean that high-quality, accessible, affordable, and effective healthcare can be provided through digital tools.
By Dr. Michael Blackman, medical director, population health and analytics, Allscripts.
Dr. Michael Blackman
As healthcare delivery continues to evolve, healthcare technology needs to be there to support it. But, how will technology facilitate healthcare as we move forward?
Healthcare accessibility, especially for certain populations, continues to be problematic. The expansion of telemedicine has the potential to improve access, especially for populations that have difficulty accessing care, such as those with mobility or transportation issues.
Additionally, looking from a primary care standpoint alone, a fair percentage of patient visits can be conducted remotely while continuing to insure care quality. Telemedicine can extend a clinician’s reach by freeing up office time for those who gain extra benefit from being seen in person. However, the technology must support both the clinician and patient interaction, while not creating new barriers.
Potential barriers can come not just from factors implicit in the technology, but from the way it is implemented as well. For example, simple things such as a clinician needing to turn his or her back to a patient to access the system disrupts the clinician/patient relationship. Workflow considerations need to be front and center for all technology-related changes.
Leverage what you have – especially the data
There’s continually a desire to pursue the next shiny object, the next buzzword, the next big technology. But it comes down to why? What are you trying to accomplish with new technology that you can’t already do today? If it serves a strategic goal, then the new technology may be highly beneficial, but have you optimized what you are using now?
Electronic health records (EHRs) and other healthcare technology have brought us a plethora of data, but how many of us are using this data effectively?
The original goal of capturing data in EHRs was to improve care. We need to use that data to understand and improve care delivery. Sometimes that requires new technology, but whether one is using new technology or not, improving care requires a change in the way business is conducted.
Are AI and machine learning the future of healthcare?
Both AI and machine learning are likely to be integral components of healthcare’s future, but the underlying culture and business framework supporting these technologies will determine if we are able to get the most from them. Differences in organizational culture and business processes often explain why some succeed and others fail using the same technology.
Definitive Healthcare released results from its 2019 Outpatient Telehealth Study. In this survey, Definitive Healthcare polled physicians and healthcare administrators to determine to determine telehealth adoption trends, technology, and services.
• Adoption Remains Flat 2018 to 2019: Adoption rates of telehealth solutions/services by outpatient physician practices remained relatively flat from 2018 to 2019, lingering at about 44 percent. However, the mix of telehealth technology solutions did shift this year, with an increase in two-way video/webcam, mobile applications for concierge services, and clinical grade remote patient monitoring devices.
• Telehealth Technologies Regarded Effective: Physician practices with telehealth solutions already in place rated the effectiveness of these technologies relatively high at an average of 6.51 out of 10 – well above the midpoint, and above all other survey categories. This indicates that, despite hurdles that hinder telehealth investment or adoption, these solutions are effective when in use.
• Providers with Telehealth Solutions Likely to Re-Invest: Roughly 65 percent of physician practices with a telehealth solution already in place plan to make further investments, up from 45 percent in 2018. Nearly 90 percent that plan to make an investment plan to do so in the next 18 months.
• No Need to Fix What’s Not Broken: Unlike the inpatient market, the priciness of telehealth solutions was not the primary barrier for outpatient adoption. In this survey, the majority of respondents (20.2%) cited “satisfaction with their practice’s current solutions and services” as their primary barrier when considering adopting telehealth technologies. Another major barrier for respondents, at 12.6%, was uncertainty surrounding reimbursement policies from insurance companies and at the national level.
Jason Krantz
“Based on these survey results, and the trends we’ve been observing in the market, there are three main hurdles that are currently hindering outpatient telehealth adoption. There is not only a need for more clarity around reimbursement policies, but also a need for more interoperable telehealth solutions that can be accessed through EHR or EMR systems as well as a better understanding about what types of telehealth options are available,” said Jason Krantz, CEO of Definitive Healthcare. “Until some of these issues are addressed, it may be some time before substantial outpatient investment is made in the telehealth arena.”
AMGA has endorsed two new Centers for Medicare & Medicaid Services (CMS) initiatives that are designed to ensure providers have access to claims data. Expanding access to administrative claims data for providers and their patients has been a longstanding AMGA priority.
The initiatives include Data at the Point of Care (DPC) and MyHealthEData. DPC is a new pilot application programming interface (API) program that would make beneficiaries’ Medicare claims data available to the provider for treatment. MyHealthEData, relies on Medicare’s Blue Button 2.0 initiative to provide beneficiaries and their providers with claims data. AMGA appreciates CMS enabling providers to access Medicare beneficiary claims data directly within their existing workflows through APIs, and we share CMS’ belief that access to a patient’s complete health record is crucial to managing a patient population and improving health outcomes.
Jerry Penso
“Access to claims data from all payers has been a longstanding priority for AMGA and its members,” Jerry Penso, M.D., M.B.A., AMGA president and CEO, said. “CMS’ latest initiatives support AMGA’s work by allowing providers to access Medicare claims data, and in effect, ensuring the successful transition from volume to value. If successful, CMS’ initiatives should inspire commercial insurers to follow suit in data sharing, a crucial step in delivering the most effective care for patients and improving health outcomes.”
Over the past four years, AMGA members repeatedly have indicated that access to timely Medicare and commercial payer administrative claims data is the most significant barrier to assuming risk. The DPC pilot and the MyHealthEData initiative could benefit organizations transitioning to value-based care. A study in the Annals of Internal Medicine further found that access to this data could be very helpful in providing effective courses of treatment with patients; however, care coordination challenges were still present. AMGA looks forward to working with CMS to help ensure the success of these initiatives and demonstrate the need for data sharing in the commercial setting.
AMGA’s comments on the DPC pilot program and the MyHealthEData initiative are available here.
Health Level Seven International (HL7), the global authority for interoperability in health information technology, and the American Academy of Family Physicians (AAFP), the only medical society devoted solely to primary care, are pleased to announce that the Gravity Project is now part of the HL7 FHIR Accelerator Program.
The Gravity Project aims to standardize medical codes to facilitate the use of social determinants of health-related data in patient care, care coordination between the health and human services sectors, population health management, value-based payment and clinical research. Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.
The HL7 FHIR Accelerator Program is designed to assist implementers across the health care spectrum to create HL7 FHIR implementation guides and other products than can facilitate FHIR acceleration and adoption activities. Other projects within the Accelerator Program include Argonaut, Da Vinci and CARIN Alliance.
Why the Gravity Project? Unmet social needs including limited access to food, transportation and housing can negatively impact health outcomes. Research has demonstrated that addressing social and medical needs in tandem improves health outcomes and lowers costs.
“Progress in patient care and research has made significant strides with the emergence of the HL7 FHIR Accelerator Program,” said HL7 International CEO Charles Jaffe, MD, PhD. “By incorporating the social determinants of health care into our decision process, the Gravity Project will help to transform care delivery and health analytics.”
In this context of mounting interest around collecting and using SDoH data in healthcare settings, new challenges have emerged related to the capacity of existing medical terminology standards to effectively capture, use and exchange the necessary data.
The Social Interventions Research and Evaluation Network (SIREN) at the Center for Health and Community, University of California, San Francisco, was an early catalyst of the Gravity Project, convening a diverse group of stakeholders as early as November 2017 to develop a strategy for achieving consensus-based comprehensive coding standards for SDOH data capture in EHR systems.
“With funding from the Robert Wood Johnson Foundation and in partnership with EMI Advisors LLC, SIREN is pleased to be working with multiple stakeholders to meet the rapidly expanding market needs around SDOH data documentation and interoperability,” said SIREN Director and UCSF associate professor of Family and Community Medicine, Laura Gottlieb, MD, MPH. “Building on work originally supported by Kaiser Permanente and the Robert Wood Johnson Foundation, the Gravity Project’s new partnership with HL7 will strengthen the capacity for SDOH information exchange between stakeholders, including clinical providers, patients, community organizations and payers.”
The Gravity Project has established a public collaborative process initially focused on three domains: food security, housing stability and quality, and transportation access. The project is working to:
Develop use cases to support documentation for screening, diagnosis, treatment/intervention, and planning activities within EHR and related systems;
Identify common data elements and their associated value sets to support the uses cases;
Develop a consensus-based set of recommendations on how best to capture and group these data elements for interoperable electronic exchange and aggregation; and
Develop an HL7 Fast Health Interoperability Resource (FHIR) Implementation Guide based on the defined use cases and associated data sets.
“The AAFP is pleased to act as convener for the Gravity Project and support information interoperability efforts,” said Shawn Martin, senior vice president of advocacy, practice advancement and policy for the American Academy of Family Physicians. “Our vision is to transform health care by addressing the social determinants of health through efforts such as our innovative HealthLandscape geoanalytics platform and The EveryONE Project to help family physicians take action and confront health disparities head-on. The important work of the Gravity Project will advance data exchange and allow family physicians to better care for patients and communities.”
The Blue Cross Blue Shield Association (BCBSA) is an active member of HL7’s initiatives to advance interoperability, and has joined SIREN and AmeriHealth Caritas in co-sponsoring the Gravity Project launch. Additionally, both the BCBS System and AmeriHealth Caritas have several programs in place to address SDOH, including actively collecting SDOH health data, engaging community health workers, providing rides to doctor appointments, and delivering healthy, affordable meals to people’s homes.
“The social and environmental conditions in which we live, such as access to healthy food and housing or reliable transportation, are critical to our health,” said Dr. Trent Haywood, chief medical officer for BCBSA and president of the Blue Cross Blue Shield Institute. “The Gravity Project will help enable the data interoperability that allows the entire health care community to address barriers that limit the ability to achieve optimal health.”
The Gravity Project has convened more than 500 experts from across the nation including clinical and community-based provider groups and payers to health technology developers and standards stewards, to collaboratively develop recommendations for how best to capture data about food, housing, and transportation risks and needs, for interoperable electronic health information exchange.
“AmeriHealth Caritas has been actively collecting social determinants of health data from member households for the past two years to help us better address their needs,” said Andrea Gelzer, MD, senior vice president of medical affairs for AmeriHealth Caritas. “The Gravity Project affirms our collective belief that standardizing the ways in which we all collect data will enable providers, plans, and other supportive agencies to quickly and more strategically mobilize care for the populations we serve.”
Participation in the Gravity Project is open to all interested organizations and individuals.
“We are pleased to coordinate and facilitate an open, transparent, and virtual community via the HL7 suite of collaboration tools,” said Evelyn Gallego, MBA, MPH, CPHIMS, program manager for the Gravity Project, and EMI Advisors CEO. “We invite all interested parties to visit the HL7 Confluence page to learn more about the Gravity Project, including how to become a participant and/or a sponsor of this important endeavor.”
Health Level Seven International (HL7), the global authority for interoperability in health information technology, and the American Academy of Family Physicians (AAFP), the only medical society devoted solely to primary care, are pleased to announce that the Gravity Project is now part of the HL7 FHIR Accelerator Program.